Reduction in Time to Surgery for Adhesive Small Bowel Obstruction in the Gastrografin Era

Gastrografin (GG) is a common tool that is both diagnostic and therapeutic in patients with adhesive small bowel obstruction (SBO). Despite its popularity, few studies exist that evaluate its impact on clinical outcomes. Our study investigated the time from admission to the operating room (OR), the overall length of stay (LOS), and the number of surgeries before and after GG use became the standard of care.

Adults aged 18 y and older with an International Classification of Diseases (ICD-9 or ICD-10) diagnosis of SBO were identified in the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2016 (pre-GG) and 2019 to 2023 (post-GG). Multivariate linear regression was used to assess the factors associated with time to the OR and total LOS, with P ≤ 0.05 considered significant.

A total of 13,257 patients pre-GG and 7333 patients post-GG with SBO were identified. The time to the OR and LOS were significantly shorter post-GG compared to pre-GG. Post-GG time to the OR was, on average, 2.33 d versus 2.63 d pre-GG (P < 0.001). Post-GG LOS was, on average, 6.09 d versus 10.51 d pre-GG (P < 0.001). This difference persisted when adjusted for confounding clinical and demographic factors. Comparing the number of surgeries 5 y pre-GG with the 5 y post-GG, 13,257 surgeries were reduced to 7333, meaning there was a 44.7% reduction in the number of surgeries.

Patients who presented with adhesive SBO post-GG had reduced time to the OR and decreased hospital LOS compared to patients pre-GG, with an associated reduction in the number of surgeries.